- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,514.91 / $2,298.44 / $4,030.12
| Facility | | $1,514.91 | $2,298.44 | $4,030.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.35 / $420.00 / $1,140.77
| Facility | | $23.35 | $420.00 | $1,140.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.20 / $65.06 / $5,749.92
| Professional | | $33.20 | $65.06 | $5,749.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,291.79 / $2,483.66 / $3,144.55
| Facility | | $2,291.79 | $2,483.66 | $3,144.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.20 / $62.70 / $113.11
| Professional | | $33.20 | $62.70 | $113.11 |